Doulas, Once a Luxury, Are Increasingly Covered by Medicaid — Even in GOP States

As Doula Postpartum, Dawn Oliver does his best in the middle of the night.

During a typical change, she presents herself at the home of her customers at 10 p.m., she answers the questions they can have on basic care of infants and keep an eye on the signs of postpartum depression.

After bedtime, she can feed the baby a bottle or wake the mother to breastfeed. She soothes the child. Sometimes she prepares meals for the family in a pot or empty the dishwasher.

She leaves the next morning and returns, often every night, for two or three weeks in a row.

“I am certified for doing everything,” said Oliver, from Hardeeville, in South Carolina, who directs customer care services. You need a village to raise a child, as the adage says, but “the village is not what it was,” said Oliver.

Doulas are trained to provide critical support to families – before childbirth, during childbirth, and in the first intimidating days when parents are desperate for sleep and infants wake up another 24 hours a day. Although Doulas generally does not hold a medical or nurse diploma, research shows that they can improve health results and reduce disparities in racial health.

However, their services remain out of reach for many families. Oliver invoices $ 45 an hour overnight and health insurance plans often do not cover its costs. This is partly why affairs “refuse and flow,” said Oliver. Sometimes it is completely reserved for months. Other times, she spends several weeks without a customer.

It could soon change.

Two bipartite invoices, presented in separate chambers of the South Carolina General Assembly, would require both Medicaid, which pays more than half of all the births of the State and private insurers to cover the cost of the services of Doula for patients who choose to use one.

South Carolina is not an aberrant value. Even if states are preparing for significant reductions in federal funding from Medicaid during the next decade, legislatures across the country continue to adopt laws which grant access to the Doula to the beneficiaries of Medicaid. Certain laws of states already oblige private health insurers to do the same. Since the beginning of 2025, the legislators of Vermont, alongside the legislatures controlled by the Republicans in Arkansas, Utah, Louisiana and Montana, have adopted laws to facilitate the coverage of Medicaid of the services of Doula.

All in all, more than 30 states reimburse the doubles through Medicaid or implement laws to do so.

In particular, these coverage requirements align with one of the objectives of the 2025 project, whose report “Mandate for leadership”, published in 2023 by the Conservative Heritage Foundation, offered a plan for the second term of President Donald Trump. The document calls for increasing access to the doubles “for all women, whether at birth in a traditional hospital, by midwives or at home”, citing concerns about maternal mortality and postpartum depression, which can be “aggravated by bad birth experiences”. The report also recommends that federal money will not be used to train doctors, nurses or doubles to make abortions.

The Heritage Foundation did not respond to an interview request.

Meanwhile, the idea that doubles can benefit to babies, parents and budgets of the Medicaid state by reducing costly cesareans and premature birth complications are supported by an increasing research set and gain ground among the conservatives.

A study published last year in the American Journal of Public Health revealed that women registered in Medicaid who used a Doula were faced with a risk of 47% delivery per cesarean and a risk of 29% of premature birth. They were also 46% more likely to attend a postpartum assessment.

“Why wouldn’t you want someone to benefit from this type of care?” The said representative of the republican state Tommy Pope, who co -pacarraine the bill on the reimbursement of the Doula in the House of Representatives of the South Carolina. “I don’t see any reason why we shouldn’t do this.”

Pope said his daughter-in-law had given birth with the help of a doula. “It opened my eyes to the positive aspects,” he said.

Amy Chen, main lawyer for the National Health Law Program, who follows Doula’s reimbursement legislation throughout the country as part of her Doula Medicaid project, said legislators tended to support these efforts when they have a personal link with the issue.

“This is something with which many people resonate,” said Chen, “even if they themselves have never been pregnant.”

Conservative legislators who approve of abortion prohibitions at state level, she said, often vote in favor of measures that support pregnancy, maternity and child health, that these Doula reimbursement bills are intended to do.

Some Republicans have the impression that “they have to go out in favor of this,” said Chen.

Health care research also suggests that black patients, who suffer from a significantly higher maternal and infant mortality rate than white patients, can particularly benefit from Doula care. In 2022, black South Carolina infants were more than twice as likely to die of all causes before their first birthday as white infants.

This is true for women in rural areas of the country where work and delivery services have closed or never existed.

This is why Montana legislators have adopted a bill on the reimbursement of the Doula this year – to reduce gaps in health care for rural and indigenous communities. To this end, in 2023, the State promulgated a bill which obliges Medicaid to reimburse the midwives for births at home.

Senator of the Montana State, Mike Yakawich, a republican who supported the bill on the reimbursement of the Doula sponsored by the Democrat, said that pregnant women should have someone to call outside a hospital, where health services can be expensive and intimidating.

“What help can we provide for the mothers waiting for? My feeling is, it is never enough,” said Yakawich.

Britney Wolfvoice lives in the Indian reserve in the north of Cheyenne in southeast Montana, about two hours from the nearest birth hospital. In early July, she was seven months pregnant with her fourth child, a son, and said that she planned to have a doula by her side for the second time in the delivery room. During the previous pregnancy of Wolfvoice, a native Doula named Misty Pipe brought cedar oil and spraying in the delivery room, rubbed the back of Wolfvoice through the contractions and helped to guarantee that the husband of Wolfvoice was the first person that their daughter saw.

“Being in a hospital, I felt heard for the very first time,” said Wolfvoice. “I can’t explain it better than I felt at home. She was my safe place. ”

Pipe said hospitals are still associated with the government forcibly removing the children of the Amerindian houses due to colonization. His goal is to help people give people a voice during their pregnancy and childbirth.

Most of its customers cannot afford to pay for the services of Doula, said pipe, so she does not charge for her birth services, balancing her role as Doula with her day work in a post office.

“If a mother is vulnerable, she could miss a prenatal meeting or go alone, or I can take working time and take it myself,” said pipe. “No mom should have to be born in fear.”

The new law of the State will allow it to be paid for its work as Doula for the first time.

In some states that promulgated such laws, the initial participation by Doulas was low because the Medicaid reimbursement rates were not high enough. At the national level, doula reimbursement rates are improving, said Chen.

For example, in Minnesota, where, in 2013, legislators adopted one of the first Doula reimbursement invoices, Medicaid only paid $ 411 per customer for their services. Ten years later, the State had increased the reimbursement rate to a maximum of $ 3,200 per customer.

But Chen said that it is not clear how Federal Medicaid cuts could affect the fate of these state laws.

Some states that have not adopted Doula repayment invoices, including South Carolina, could hesitate to do so in this environment, she said. “It’s just a really uncertain moment.”